Ephedrine requirements are reduced during spinal anaesthesia for caesarean section in preeclampsia

Part of the Portfolio Thesis by Geoffrey H. Sharwood-Smith: The inferior vena caval compression theory of hypotension in obstetric spinal anaesthesia: studies in normal and preeclamptic pregnancy, a literature review and revision of fundamental concepts, available at http://hdl.handle.net/10023/1815Background: Despite controversy over the haemodynamically safest blockade for caesarean section in women with severe preeclampsia, an increasing number of anaesthetists now opt for spinal anaesthesia. In a previous study we found that spinal compared to epidural anaesthesia offered an equally safe but more effective option for these patients. The current study was designed to compare the hypotension induced by spinal anaesthesia, as measured by ephedrine requirement, between 20 normotensive and 20 severely preeclamptic but haemodynamically stabilised women. Method: Standardised spinal anaesthesia was instituted and ephedrine was given in boluses of 6 mg if the systolic pressure fell >20% from the baseline, or if the patient exhibited symptoms of hypotension. Results: The mean ephedrine requirement of the normotensive group (27.9 ± 11.6 mg) was significantly greater (P < 0.01) than that of the preeclamptic group (16.4 ± 15.0 mg). Conclusion: This suggests that the hypotension induced by spinal anaesthesia in women with severe but haemodynamically stabilised preeclampsia, is less than that of normotensive patients.Publisher PD

Adjustable high emittance gap filler

A flexible, adjustable refractory filler is disclosed for filling gaps between ceramic tiles forming the heat shield of a space shuttle vehicle, to protect its aluminum skin during atmospheric reentry. The easily installed and replaced filler consists essentially of a strip of ceramic cloth coated, at least along both its longitudinal edges with a room temperature vulcanizable silicone rubber compound with a high emittance colored pigment. The filler may have one or more layers as the gap width requires. Preferred materials are basket weave aluminoborosilicate cloth, and a rubber compounded with silicon tetraboride as the emittance agent and finely divided borosilicate glass containing about 7.5% B2O3 as high temperature binder. The filler cloth strip or tape is cut to proper width and length, inserted into the gap, and fastened with previously applied drops of silicone rubber adhesive

Processing of seismic data from an automatic digital recorder

Data from a three-component, long-period seismometer system is recorded in digital form on magnetic tape by a device which has been described by Miller. Preliminary editing and processing is performed to select events of interest from the 24-hour tapes and place them on a library tape that is compatible with a computer. Emphasis is placed on location, correction, and flagging of errors that occur during the recording and editing process. Processing routines developed include: correction for seismometer response, orbital motion functions, energy computation, band pass filtering for mode separation, etc. The dynamic range of the system is 86 db and the response is adequate over the range .02 to 2.0 cps. For the purpose of detailed analysis, digital records from this system are superior to paper records from any of the existing seismographs in use at this laboratory. The main disadvantage of data in this form is the difficulty of inspecting signals by eye in order to make preliminary interpretations

Transport problems facing large cities

This paper considers the problems facing transport policy in large cities. As the world’s cities have become home to the vast majority of their national population, governments are faced with the challenge of providing transport infrastructure to accommodate the needs of their citizens. In many of the world’s largest cities, the majority of travel is by private car, which poses two problems – road congestion and greenhouse gas emissions

ClgR regulation of chaperone and protease systems is essential for Mycobacterium tuberculosis parasitism of the macrophage

Chaperone and protease systems play essential roles in cellular homeostasis and have vital functions in controlling the abundance of specific cellular proteins involved in processes such as transcription, replication, metabolism and virulence. Bacteria have evolved accurate regulatory systems to control the expression and function of chaperones and potentially destructive proteases. Here, we have used a combination of transcriptomics, proteomics and targeted mutagenesis to reveal that the clp gene regulator (ClgR) of Mycobacterium tuberculosis activates the transcription of at least ten genes, including four that encode protease systems (ClpP1/C, ClpP2/C, PtrB and HtrA-like protease Rv1043c) and three that encode chaperones (Acr2, ClpB and the chaperonin Rv3269). Thus, M. tuberculosis ClgR controls a larger network of protein homeostatic and regulatory systems than ClgR in any other bacterium studied to date. We demonstrate that ClgR-regulated transcriptional activation of these systems is essential for M. tuberculosis to replicate in macrophages. Furthermore, we observe that this defect is manifest early in infection, as M. tuberculosis lacking ClgR is deficient in the ability to control phagosome pH 1 h post-phagocytosis

The Parkes HI Zone of Avoidance Survey

A blind HI survey of the extragalactic sky behind the southern Milky Way has been conducted with the multibeam receiver on the 64-m Parkes radio telescope. The survey covers the Galactic longitude range 212 < l < 36 and Galactic latitudes |b| < 5, and yields 883 galaxies to a recessional velocity of 12,000 km/s. The survey covers the sky within the HIPASS area to greater sensitivity, finding lower HI-mass galaxies at all distances, and probing more completely the large-scale structures at and beyond the distance of the Great Attractor. Fifty-one percent of the HI detections have an optical/NIR counterpart in the literature. A further 27% have new counterparts found in existing, or newly obtained, optical/NIR images. The counterpart rate drops in regions of high foreground stellar crowding and extinction, and for low-HI mass objects. Only 8% of all counterparts have a previous optical redshift measurement. A notable new galaxy is HIZOA J1353-58, a possible companion to the Circinus galaxy. Merging this catalog with the similarly-conducted northern extension (Donley et al. 2005), large-scale structures are delineated, including those within the Puppis and Great Attractor regions, and the Local Void. Several newly-identified structures are revealed here for the first time. Three new galaxy concentrations (NW1, NW2 and NW3) are key in confirming the diagonal crossing of the Great Attractor Wall between the Norma cluster and the CIZA J1324.7-5736 cluster. Further contributors to the general mass overdensity in that area are two new clusters (CW1 and CW2) in the nearer Centaurus Wall, one of which forms part of the striking 180 deg (100/h Mpc) long filament that dominates the southern sky at velocities of ~3000 km/s, and the suggestion of a further Wall at the Great Attractor distance at slightly higher longitudes.Comment: Published in Astronomical Journal 9 February 2016 (accepted 26 September 2015); 42 pages, 7 tables, 18 figures, main figures data tables only available in the on-line version of journa

Large scale motions of Neptune's bow shock: Evidence for control of the shock position by the rotation phase of Neptune's magnetic field

The Voyager 2 spacecraft observed high levels of Langmuir waves before the inbound crossing of Neptune's bow shock, thereby signifying magnetic connection of the bow shock. The Langmuir waves occurred in multiple bursts throughout two distinct periods separated by an 85 minute absence of wave activity. The times of onsets, peaks, and disappearances of the waves were used together with the magnetic field directions and spacecraft position, to perform a 'remote-sensing' analysis of the shape and location of Neptune's bow shock prior to the inbound bow shock crossing. The bow shock is assumed to have a parabolidal shape with a nose location and flaring parameter determined independently for each wave event. The remote-sensing analysis give a shock position consistent with the time of the inbound shock crossing. The flaring parameter of the shock remains approximately constant throughout each period of wave activity but differs by a factor of 10 between the two periods. The absence of waves between two periods of wave activity coincides with a large rotation of the magnetic field and a large increase in the solar wind ram pressure' both these effects lead to magnetic disconnection of the spacecraft from shock. The planetwards motion of the shock's nose from 38.5 R(sub N) to 34.5 R(sub N) during the second time period occurred while the solar wind ram pressure remained constant to within 15 percent. This second period of planetwards motion of the shock is therefore strong evidence for Neptune's bow shock moving in response to the rotation of Neptune's oblique, tilted magnetic dipole. Normalizing the ram pressure, the remotely-sensed shock moves sunwards during the first wave period and planetwards in the second wave period. The maximum standoff distance occurs while the dipole axis is close to being perpendicular to the Sun-Neptune direction. The remote-sensing analysis provides strong evidence that the location of Neptune's bow shock is controlled by Neptune's rotation phase

Diagnosis and treatment of a caecal mucocoele in a dog

An 11‐year‐old male intact Staffordshire Bull terrier was referred for diabetic ketoacidosis. Abdominal ultrasonographic examination revealed a 5 cm × 2 cm intraluminal caecal mass‐like structure. Exploratory laparotomy and typhlectomy were subsequently performed. Histopathology of the caecal mass‐like structure was consistent with a caecal mucocoele, defined as a cystic dilation of the caecal lumen with stasis of mucus. This lesion has been previously described in humans, where it is termed an appendiceal mucocoele. The patient was euthanased 58 days post‐operatively due to unrelated diabetic complications

Universal screening for meticillin-resistant Staphylococcus aureus : interim results from the NHS Scotland pathfinder project

Following recommendations from a Health Technology Assessment (HTA), a prospective cohort study of meticillin-resistant Staphylococcus aureus (MRSA) screening of all admissions (N = 29 690) to six acute hospitals in three regions in Scotland indicated that 7.5% of patientswere colonised on admission to hospital. Factors associated with colonisation included re-admission, specialty of admission (highest in nephrology, care of the elderly, dermatology and vascular surgery), increasing age, and the source of admission (care home or other hospital). Three percent of all those who were identified as colonised developed hospital-associated MRSA infection, compared with only 0.1% of those not colonised. Specialtieswith a high rate of colonisation on admission also had higher rates of MRSA infection. Very few patients refused screening (11 patients, 0.03%) or had treatment deferred (14 patients, 0.05%). Several organisational issues were identified, including difficulties in achieving complete uptake of screening (88%) or decolonisation (41%); the latter was largely due to short duration of stay and turnaround time for test results. Patient movement resulted in a decision to decontaminate all positive patients rather than just those in high risk specialties as proposed by the HTA. Issues also included a lack of isolation facilities to manage patients with MRSA. The study raises significant concerns about the contribution of decolonisation to reducing risks in hospital due to short duration of stay, and reinforces the central role of infection control precautions. Further study is required before the HTA model can be re-run and conclusions redrawn on the cost and clinical effectiveness of universal MRSA screening

Dysphagia rehabilitation following acquired brain injury, including cerebral palsy, across the lifespan: a scoping review protocol

BACKGROUND: Swallowing impairment (dysphagia) following brain injury can lead to life-threatening complications such as dehydration, aspiration pneumonia and acute choking episodes. In adult therapeutic practice, there is research and clinical evidence to support the use of swallowing exercises to improve swallowing physiology in dysphagia; however, the use of these exercises in treating children with dysphagia is largely unexplored. Fundamental questions remain regarding the feasibility and effectiveness of using swallowing exercises with children. This review aims to outline the published literature on exercise-based treatment methods used in the rehabilitation of dysphagia secondary to an acquired brain injury across the lifespan. This will allow the range and effects of interventions utilised to be mapped alongside differential practices between adult and child populations to be formally documented, providing the potential for discussions with clinicians about which rehabilitative interventions might be appropriate for further trial in paediatrics. METHODS: This study will use a scoping review framework to identify and systematically review the existing literature using Joanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic Reviews (PRISMA) scoping review guidelines. Electronic databases (MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine Database (AMED)), grey literature and the reference lists of key texts including systematic reviews will be searched. Information about the rehabilitation design, dosage and intensity of exercise programmes used as well as demographic information such as the age of participants and aetiology of dysphagia will be extracted. The number of articles in each area and the type of data source will be presented in a written and visual format. Comparison between the literature in adult and child populations will be discussed. DISCUSSION: This review is unique as it directly compares dysphagia rehabilitation in adults with that of a paediatric population in order to formally identify and discuss the therapeutic gaps in child dysphagia rehabilitation. The results will inform the next stage of research, looking into the current UK-based speech and language therapy practices when working with children with acquired dysphagia. SYSTEMATIC REVIEW REGISTRATION: Open science framework osf.io/ja4dr